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April 11-13, 2019
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American College of Physicians policy paper recommendations
consider full array of drugs, not only opioids
December 10, 2013
(Washington) - Ten policy positions and recommendations to
address the significant human and financial costs related to
prescription drug abuse were provided by the American College of
Physicians (ACP) in a policy paper released yesterday. Prescription
Drug Abuse forms a framework for patients to receive the
care they require while effectively accounting for the problems
associated with the use of prescription drugs - specifically those
with a significant potential for abuse.
"Prescription drug abuse is found throughout all aspects of our
population and is a serious public health problem," said Molly
Cooke, MD, FACP, president of ACP. "Physicians and other health
professionals with prescribing privileges are entrusted with the
authority to use medications in the treatment of their patients and
therefore have an important role to play in helping to ensure safe
and effective use of this treatment option and the deterrence of
Physicians have an ethical obligation to manage and relieve
pain, but to do so responsibly and in accord with scientific
evidence, according to ACP's Ethics Guidelines. Improvement in
function through the short-term use of opioids and related
substances to treat acute pain and their use to ease suffering at
end-of-life are well-accepted medical practices. However, long-term
opioid use for chronic pain is controversial because of concerns
about addiction, overuse, misuse, and side effects.
The ACP paper distinguishes itself by noting that controlled
substances include medications not only for the treatment of pain,
but to treat sleep disorders, nerve conditions, weight loss and
other conditions. Improvement in function through the short-term
use of opioids and related substances to treat acute pain and their
use to ease suffering at end of life are well accepted medical
The paper includes a definition of drug abuse, information about
prescription drug abuse in different age groups, variation by
geographic area, prescription drug abuse and fraud in Medicare, and
factors contributing to the dramatic rise in the availability and
misuse of prescription drugs.
"ACP supports efforts to educate physicians, patients, and the
public on the appropriate medical uses of controlled drugs and the
dangers of both medical and non-medical use of prescription drugs,"
Dr. Cooke said as she cited one of the paper's recommendations.
Long-term opioid use for chronic pain is controversial because
of concerns about addiction, overuse, misuse, and side effects.
Long-term use can also lead to opioid-induced heightened pain
sensitivity, which in turn leads to increased doses of opioids,
further escalating sensitivity to pain.
Prescribing controlled substances, which can be addictive or
abused, can subject physicians to substantial regulatory and
administrative burdens. There are criminal and civil penalties,
including loss of licensure (and consequent inability to practice)
for failure to comply with state and federal laws regulating
controlled substances. On the other hand, failure to adequately
medicate a patient can expose a physician to malpractice charges of
negligence. Physicians can also be sued for overmedication that
results in addiction or serious side effects. State medical boards
also report addressing complaints for both overtreatment and under
treatment of pain.
The American College of Physicians is the
largest medical specialty organization and the second-largest
physician group in the United States. ACP members include 137,000
internal medicine physicians (internists), related subspecialists,
and medical students. Internal medicine physicians are specialists
who apply scientific knowledge and clinical expertise to the
diagnosis, treatment, and compassionate care of adults across the
spectrum from health to complex illness. Follow ACP on Twitter and Facebook.
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